Mobile Health Application to Improve HIV Medication Adherence

 描述(申请人提供)：有100多万美国人感染了艾滋病毒。高效的抗逆转录病毒疗法(ART)使艾滋病毒携带者(PLWH)有可能拥有更长、更健康的生命。尽管治疗取得了进展，但只有四分之一的PLWH成功地将病毒控制住了。药物不依从性是导致病毒抑制失败的一个重要因素。因此，制定了以坚持为目标的干预措施，大多数干预措施在短期内显示出一定程度的成功。然而，这些干预措施的影响通常不会随着时间的推移而持续，而且在大多数艾滋病毒治疗环境中提供更密集的遵从性干预措施是不可行的。因此，人们一直对开发有效的电子传递干预措施感兴趣。这项工作仍处于初级阶段，很少有工作是 已做的工作是为了建立移动健康艺术坚持应用的有效性。移动保健应用程序将最大限度地提高干预措施的便携性，并允许实时遵守、跟踪和反馈，并随时访问内容或服务，以加强遵守。本提案旨在开发和改进移动健康艺术依从性应用，并进行初步的随机对照试验(RCT)，比较面对面的ART依从性干预之后的移动健康艺术依从性应用(MARTAA)和单独的面对面依从性干预，其接近护理标准(SOC)。这一系列研究的长期目标是传播一种有效的、可移动的健康艺术坚持应用，该应用可以很容易地整合到临床护理中。在拟议研究的第一阶段，我们将根据从试点参与者(n=20)收集的数据，使用试点和修改的迭代过程来开发和完善MARTAA。第二阶段(n=60)将包括比较mARTAA和SOC的初步随机对照试验。随机对照试验的参与者将在1、3、6和12个月完成基线访谈和后续访谈。主要结果变量将是基于电子药盒数据的ART依从性。我们期望，作为这个项目的结果，我们将开发并展示移动健康应用程序的有效性，以提高ART依从性，这种应用程序可以轻松地传播到现实世界的临床环境中。这种干预措施有望改善对艾滋病毒的抑制，减缓疾病进展，减少与艾滋病毒有关的发病率和死亡率，降低其他人感染艾滋病毒的风险，并最大限度地减少艾滋病毒耐药株的产生。

 DESCRIPTION (provided by applicant): There are more than a million Americans who are infected with HIV. Highly effective antiretroviral therapy (ART) makes it possible for persons living with HIV (PLWH) to have longer, healthier lives. Despite treatment advances, only a quarter of PLWH successfully keep the virus under control. Medication non-adherence is a significant contributor to unsuccessful viral suppression. As a result, interventions targeting adherence have been developed, with most interventions demonstrating some degree of success in the short-term. However, the impact of these interventions is generally not sustained over time, and it is not feasible to deliver more intensive adherence interventions in most HIV treatment settings. As a result, there has been interest in developing efficacious electronically-delivered interventions. This work is still in its infancy, and there is a paucity of work that has been done to establish the efficacy of mobile health ART adherence applications. A mobile health application would maximize the portability of the intervention and allow for real-time adherence tracking and feedback and ready access to content or services to enhance adherence. The present proposal aims to develop and refine a mobile health ART adherence application and to conduct a preliminary randomized controlled trial (RCT) comparing a face-to-face ART adherence intervention followed by the mobile health ART adherence application (mARTAA) to the face-to-face adherence intervention alone, which approximates standard-of-care (SOC). The long-term goal of this line of research is to disseminate an efficacious, mobile health ART adherence application that can be integrated readily into clinical care. In Phase 1 of the proposed study, we will develop and refine mARTAA using an iterative process of piloting and modification based on data collected from pilot participants (n=20). Phase 2 (n=60) will consist of a preliminary RCT comparing mARTAA and SOC. Participants in the RCT will complete a baseline interview and follow-up interviews at 1, 3, 6, and 12 months. The primary outcome variable will be ART adherence based on electronic pill box data. We expect that, as a result of this project, we will have developed and demonstrated the efficacy of a mobile health application to improve ART adherence that can be disseminated easily into real-world clinical settings. Such an intervention holds the promise of improving HIV viral suppression, slowing disease progression, reducing HIV-related morbidity and mortality, decreasing the risk of HIV infection in others, and minimizing the production of treatment resistant strains of HIV.